Supportive Services

Hospital Services
• 1)Line Services
• 2)Supportive Services //Staff services
• 3)Auxiliary Services
• 1)Line services
• Line service in the hospital is the care which is
directly related to the patient treatment.
• Line Services include
• Emergency services
• Out-Patient services
• In-patient services (Wards)
• Intensive Care Unit (ICU)
• Operation Theatre (OT)
• 2)Support services
• Support services are the services which are not directly
related to patient care but, indirectly contribute in patient
management. Support services include.
• Central Sterile Supply Department (CSSD)
• Diet Management
• Pharmacy Services
• Laundry
• Laboratory
• Radiology
• Nursing Services
• 3)Auxiliary Services
• Auxiliary services in hospital activities which are directly
related to neither care, nor support care, but contribute to
facilitate the service. The Auxiliary service include
• Registration and Indoor case records
• Stores
• Transport
• Mortuary
• Dietary Services
• Engineering and Maintenance services
• Hospital Security
 Medical Records
• Characteristics of good medical record
• Accurate : Medical record should be accurate.
Otherwise, there is no meaning of keeping medical
records. To justify the purpose medical record should
be accurate.
• Complete : It must contain sufficient data written in
sequential order of events to justify the diagnosis and
warrant the treatment.
• Adequate : Medical records should contain all the
necessary information and complete progress not
written by the attending doctor.
• Comprehensive : Medical records should contain
comprehensive and adequate information to point and easily
understood.
• Economical : Medical records should be economical. It
should not be over burden economically on administration to
maintain.
• Properly planned : Medical records should be kept
according to scientific methods such as arrangements of
shelves, filing, indexing, coding etc. should be on proper
sequence and easy to understand.
• Timely : It should be time saving rather than time
consuming to maintain, retrieve and enter the data and so on.
 Components of medical record

• i)Social data :
• It consists of general information regarding
patient's identification such as his name, age,
sex, community, religion, residential address,
marital status, occupation, address and so on.
Most of this information should furnish during
the admission at the admission counter or
during the registration of the patient.
• ii)
 Administrative data :

• It consists of patient's OPD registration

number, name of the OPD, name of the
unit head, X-ray registration number and
other investigation, reference number.
This information is helpful for coding,
indexing and filing of the patient record
and to maintain and retrieve the files
systematically.
 Clinical data
• Clinical data could be collected at two
levels – OPD and Ward. It consists of past
history (family history and past illness),
physical examination, provisional
diagnosis, advice, follow-up at the OPD
level.
• In the ward level, it consists of admission
record, progress note, summary sheet,
discharge summary, doctor's note,
operation note, nurses bedside record,
investigation report, graphic charts,
recommendations and so on.
 Central Sterile Services
Department (CSSD)
• The main objectives of both SSD and
CSSD are the same i.e. to supply
sterilized and disinfected equipments, free
of bacteria to the user department.
• 
• It is directly related to quality care provided
by the hospitals and also related to
positive impact of the society and the cost
and benefits to the organization it self.
• It is the department responsible for
processing, sterilizing and dispensing of
almost all items for sterile equipment sets
and dressings in the hospitals.
 Need for Centralization
• For economic reason, efficiency of
operations and maintenance of high
standard, hospitals have found it
preferable for all reusable supplies and
equipment requiring special cleaning,
disinfection or sterilization to be handled
centrally whenever possible.
 Objectives of Central Sterile Services
Department (CSSD)

• The objectives of central service include

the following :
To provide inventoried supplies and
equipment to customer areas.

• To promote better patient care by
providing prompt and accurate service.
To provide supplies of sterile linen
packs, basins, instruments, and other
sterile items.
• To maintain an accurate record of the
effectiveness of the cleaning, disinfecting,
and sterilizing processes.
• To strive for uniformity and simplicity in
the trays and sets that the department
provides.
• To maintain an adequate inventory of
supplies and equipment.
• To monitor and enforce controls
necessary to prevent cross infection
according to infection control policies.
• To establish and maintain sterile
processing and distribution standards.
• To operate efficiently to reduce overhead
expense.
• To stay abreast of developments in the
field and to implement changes as needed
to stay current with new regulations and
recommended practices.
• To review current practice for possible
improvements in quality or services
provided.
• .
• To provide consulting services to other
departments in all areas of sterile
processing and distribution, including in-
service education programs, review
policies and procedures, and
implementation of new processes
 Functions of Central Sterile Services
Department (CSSD)
• i)Decontamination Process
• Decontamination is the physical or
chemical process that renders an
inanimate object that may be
contaminated with harmful microbial life
safe for further handling.
 Steps in the Decontamination
Process
• Transport
• .Equipment should be covered and supplies
should be moved in covered carts, closed totes
or containers, or closed plastic bags.
• Attire
• Should wear protective clothing, which includes
a scrub uniform covered by a moisture-resistant
barrier, shoe covers, rubber or plastic gloves,
and a hair covering
• Sorting – Sorting begins at the point of
use. Handling of contaminated items
should be minimized
• Washing
• Detergent – Should be compatible with
the materials in the device and suited for
the type of soil. Consult the
recommendations from the device
manufacturer.
–Equipment
–Ultrasonic
–Inspection
• ii)Assembly & Packaging Process
• Types of Packaging
• Textiles
• Nonwovens
• Pouch packaging
• Rigid container systems
 iii)Sterilization Process
• Steam
• Ethylene Oxide
• Dry heat
 iv)Administrative Monitoring
• Work practices must be supervised.
Written policies and procedures must be
strictly followed by all personnel
responsible and accountable for sterilizing
and disinfecting items,
• Decontaminating, terminally sterilizing,
and cleaning all reusable items; disposing
of disposable items.
• Packaging and labeling of items.
• Loading and unloading the sterilizer.
• Operating the sterilizer.
• Monitoring and maintaining records of
each cycle.
• Adhering to safety precautions and
preventive maintenance protocol.
• Storing of sterile items.
• Handling sterile items ready for use.
• Making sterile transfer to a sterile field.
 Responsibility of Pharmacist in
Hospital Pharmacy
• 1.Drug Distribution Standard
• Every pharmacist manager shall be
responsible for the purchasing, receiving,
storage, distribution and disposal of drugs
in the pharmacy.
• 2.Interpretation
• Community Practice.
• Hospital Practice.
• 3.Procurement of Drugs
• 4.Receiving/Storage of Drugs
• Disinfectants and drugs for external use
are stored separately from internal and
injectable medications.
• Drugs requiring special environmental
conditions for stability are properly stored.
• No outdated drugs are stocked.
• controlled drugs substances are being
stored with proper measures of security.
• Drugs are not being overstocked.
• Drugs which may be required on an urgent
or emergency basis are in adequate and
proper supply.
• Patient medications no longer required are
returned to pharmacy.
• Standards of neatness and cleanliness are
consistent with good medication handling
practices.
 5.Inventory Control
• The patient's name, age, hospital number and
location.
• The name of medication and dosage.
• Route and frequency of administration.
• Duration of treatment, if limited.
• Name of authorized prescriber.
• Date the order was written.
• The time the order was written, if deemed appropriate.
• For verbal orders, the name and signature of the
person who received the order.
• 7.Unit-Dose Medication System

• The following information shall be indicated

on the individual dosage package :
• Name of drug
• Strength
• Expiry date
• Lot number
• 8.Individual Patient Prescription
• a)Name of the patient and location
• b)Name and strength of the drug
• c)Dose
• d)Route of administration
• e)Accessory or cautionary statements as
required
• f)Date dispensed
• g)Name of hospital
 Pharmacy Services
• Hospital Pharmacy
• A good pharmacy is a blend of several
things :
• Qualified personnel, Modern facilities,
Efficient organization and operations,
sound budgeting and the support and
cooperation of the medical, nursing and
administrative staff of the hospital.
 Role of Clinical Pharmacist
1.Medicine Assessment
• The pharmacy team provides the leadership,
systems support and expertise that enables a
multidisciplinary team to :
• Reconcile patients’ medicines as soon as
possible, ideally within 24 hours of hospital
admission to avoid unintentional changes to
medication.
• Effectively document patients’ medication
histories as part of the admission process.
• 
• Give patients access to the medicines that they
need from the time that their next dose is
needed.
• Identify patients in need of pharmacy support
and pharmaceutical care planning.
• Identify potential medicines problems
affecting discharge (or transfer to another care
setting) so that they can be accommodated to
avoid extending patients’ stays in hospital.
 2.Care as an inpatient
• Patients have their medicines reviewed by
a clinical pharmacist to ensure that their
medicines are clinically appropriate, and to
optimise their outcomes from their
medicines.
• a.Pharmacists regularly clinically review
patients and their prescriptions to optimise
outcomes from medicines (timing and level
of reviews adjusted according to patient
need and should include newly prescribed
medicines out of hours) and take steps to
minimise omitted and delayed medicine
doses in hospitals.
• b.Patients targeted for clinical pharmacy
support have their medicines’ needs
assessed and documented in a care plan
that forms part of the patient record.
• c.Pharmacists attend relevant
multidisciplinary ward rounds, case reviews
and/or clinics.
• d.Patients, medical and nursing teams have
access to pharmacy expertise when needed.
• e.The pharmacy team provides the
leadership, systems support and expertise
that enables patients to :
• Bring their own medicines into hospital
with them and self-administer one or more
of these wherever possible.
• Have their own medicines returned at
discharge where appropriate.
3.Monitoring patients’ outcomes
• a.As part of a multidisciplinary team,
pharmacy team members monitor:
• Patients’ responses to their medicines
• Unwanted effects of medicines.
• b.Appropriate action is taken where problems
(potential and actual) are identified.
• c.The pharmacy team provides the
leadership, systems support and expertise
that enables healthcare professionals to:
• Help patients to avoid adverse events
resulting from their medicines
• Document, report and manage any adverse
events that do arise.
• Continuity of care for patients not admitted
Patients who are taking medicines at
home or in non-acute care settings have
access to continuing supplies of medicines
and to pharmacy services and support
appropriate to their care.
a.Systems are in place to ensure patients
whose care does not involve admission
can access medicines when they need
them.
b.
• Patients (and/or their healthcare
professionals) have access to the
pharmacy expertise that they need to
optimize their medicines.
 Responsibility of Pharmacist in
Hospital Pharmacy
• Pharmacy means a making availability of
all the drugs and pharmaceuticals needed
for patients care, according to the hospital
formulary, the right drug in the right
formulation and dosage.
• 1.Drug Distribution Standard
• Every pharmacist manager shall be
responsible for the purchasing, receiving,
storage, distribution and disposal of drugs
in the pharmacy.
• 2.Interpretation
• All areas of practice pharmacy support
personnel may be utilized to reduce the
professional time committed to the
mechanics of the drug distribution service
without reducing the professional and legal
control.
• Community Practice.
• Hospital Practice.
• 3.Procurement of Drugs
• The purchase of all drugs shall be under
the supervision of a pharmacist and in
accordance with the formulary standard.
• The pharmacy department shall
establish and maintain adequate records
of drug purchases necessary for inventory
control and legal requirements.
• 4.Receiving/Storage of Drugs
• The pharmacy personnel shall make
regular inspections of all drugs storage
areas. A written record shall verify that :
• o
• Disinfectants and drugs for external use are
stored separately from internal and
injectable medications.
• oDrugs requiring special environmental
conditions for stability are properly stored.
• oNo outdated drugs are stocked.
• oNarcotics and controlled drugs substances
are being stored with proper measures of
security.
• oDrugs are not being overstocked.
• oDrugs which may be required on an urgent
or emergency basis are in adequate and
proper supply.
• oPatient medications no longer required are
returned to pharmacy.
• oStandards of neatness and cleanliness are
consistent with good medication handling
practices.
• 5.Inventory Control
• The pharmacist shall maintain an
inventory control system. There shall be
drug recall procedures that can be readily
implemented.
• Ordering the text of the medication orders
shall include :
• 
• 5.Inventory Control
• The pharmacist shall maintain an
inventory control system. There shall be
drug recall procedures that can be readily
implemented.
• Ordering the text of the medication orders
shall include :
• 
• The patient's name, age, hospital number
and location.
• The name of medication and dosage.
• Route and frequency of administration.
• Duration of treatment, if limited.
• Name of authorized prescriber.
• Date the order was written.
• The time the order was written, if
deemed appropriate.
• For verbal orders, the name and
signature of the person who received the
order.
 .Individual Patient Prescription

• a)Name of the patient and location

• b)Name and strength of the drug
• c)Dose
• d)Route of administration
• e)Accessory or cautionary statements as
required
• f)Date dispensed
• g)Name of hospital
• 12.Ward Stock Medications
• The pharmacy shall establish a list of ward
stock medications for each ward and that
list shall be reviewed on an annual basis
by the pharmacy department. The supply,
distribution and control of ward stock
medication shall be the responsibility of
thepharmacy department.
• 13.Investigational Drugs
• Investigational and emergency release
drugs shall :
• a)Be used only under the direct
supervision of the principal investigator.
• b)Be approved for use by the appropriate
hospital committees.
• c)
• Be administered by personnel only after
they have been given appropriate
pharmaceutical information about the
drugs.
• Be the responsibility of the pharmacy
department for storage and distribution.